To examine the effects of dietary fatty acids and carbohydrate on plasma lipids and lipoproteins, 11 patients with a mean plasma total cholesterol level of 251±10 mg per deciliter were studied on a metabolic ward during three dietary periods, each lasting four weeks. A liquid diet rich in monounsaturated fatty acids (“High-Mono”) and a diet low in fat (“Low-Fat”) were compared with a diet high in saturated fatty acids (“High-Sat”). The High-Sat and High-Mono diets contained 40 percent of their total calories as fat and 43 percent as carbohydrate; the Low-Fat diet had 20 percent fat and 63 percent carbohydrate. Body weight was kept constant by adjusting total caloric intake. As compared with the High-Sat diet, both the High-Mono and Low-Fat diets lowered plasma total cholesterol (by 13 percent and 8 percent, respectively) and low-density lipoprotein cholesterol (by 21 percent and 15 percent, respectively). As compared with the High-Sat diet, the Low-Fat diet raised triglyceride levels and significantly reduced plasma high-density lipoprotein cholesterol. In contrast, the High-Mono diet had no effect on levels of triglycerides or high-density lipoprotein cholesterol. The ratio of low-density to high-density lipoprotein cholesterol was also significantly lower when the High-Mono diet rather than the Low-Fat diet was followed. Therefore, in short-term studies in which liquid diets are used and body weight is kept constant, a diet rich in monounsaturated fatty acids appears to be at least as effective in lowering plasma cholesterol as a diet low in fat and high in carbohydrate. (N Engl J Med 1986; 314: 745–8.), HIGH levels of plasma cholesterol constitute a risk factor for coronary heart disease,1 2 3 and a dietary approach to preventing such disease by reducing plasma cholesterol is widely advocated.4,5 The diet usually recommended for lowering cholesterol is low in total fat, saturated fatty acids, and cholesterol.4 5 6 Such a diet is followed in many countries where the prevalence of coronary heart disease is relatively low.7 Exceptions are found in certain locations in the Mediterranean region.1,7 In countries such as Greece and in southern Italy, the traditional diet is high in olive oil, and total intake of fat can be high. In these.
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